amalgam and composite restorations class i, ii, v posterior class iii, iv anterior amalgam or...
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AMALGAM AND COMPOSITE RESTORATIONS
class I, II, V posterior class III, IV anterior amalgam or composite
in posterior gold and porcelain anterior - composite or
porcelain
basic procedures– anesthetic, dental dam,
remove decay– place matrix band, if
needed, wedges if needed
– place restorative material
– finish restoration
Classification of Cavities
Class I – Pit and Fissure– No tofflemire or matrix required– Amalgam or composite
Class II – Posterior interproximal and occlusal– Tofflemire or Mylar matrix required– Amalgam or composite
Classification of Cavities
Class III – anterior interproximal (no incisal edge)– Mylar strip– Composite
Class IV – anterior interproximal with incisal edge– Mylar strip– Composite
Classification of Cavities
Class V – cervical 1/3– Composite– Glass ionomer (type II)
CAVITY PREPARATION
It is a surgical operation basic principles
– outline form– resistance form– retention form
mechanical vs chemical
– convenience form– removal of caries
– Finishing of enamel walls– extension for prevention– cavity debridement– line angles – point angles
CAVITY PREPARATION
Formed by the junction of 2 walls in the cavity prepLine Angles
Point angles
AMALGAM MATERIAL
Advantages– used in posterior only– strong to with stand
compressive pressures(160 lbs. pressure)
– Malleable (soft and easily shaped when freshly mixed)
– durable– inexpensive
Disadvantages– mechanical retention
only– not esthetically pleasing– contains mercury
AMALGAM MATERIAL
Can be used for:– posterior restorations– core buildups– delivered in capsules or
bulk– today most offices use
high copper amalgam, less mercury
Composition– mercury– silver– tin– copper– zinc
AMALGAM MATERIAL
Combination of two or more metals mercury liquid at room temperature Once mixed, amalgam cannot be reused Ratio – one to one Controversial
– health hazard– environmental hazard
Amalgamator
Amalgamation Tritturation
– quality of mix is determined by mixing time
– too long - soupy, sets quickly
– too short - dull, crumbles
Preparation– class II requires
tofflemire and band– anatomy placed in
material with carvers T-3 Hollenback Discoid/Cleoid
Retention Pins
Used for additional retention Vital or non-vital teeth Can be drilled into tooth with a self-threaded
hand driver or cemented Used for large restoration Titanium
Composite Restorations
Also called resins Advantages:
– Tooth colored– Esthetically pleasing– Bonded directly to the tooth– Reduced microleakage
Disadvantages– Strength – occlusal wear resistance is improving– Discoloration around borders after time
COMPOSITE MATERIAL
Advantages:– esthetically pleasing– wear resistance is
improving– resist fracture– mechanical and
chemical retention– expansion/contraction
similar to tooth structure
Disadvantage:– is not as durable as
amalgam for posterior use (but improving)
– Has to be placed in dry environment
– Technique sensitive – can discolor at margins
COMPOSITE MATERIAL
Sometimes fails
COMPOSITE MATERIAL
Sometimes Work Well
COMPOSITE MATERIAL
Types– light cure – self cure– dual cure
Components– resin material– polymer - powder– monomer - liquid– polymerization - to set
Uses:– class I,II, III,IV, V– core build ups– veneers
Composite make up
Composite is a combination of polymers and monomers
– resins– fillers– coloring
Filler:– originally quartz - good
translucent appearance, strong and hard, difficult to polish to high shine
– silica particles, chemically produced
– macrofills– microfills– hybrid
Composite make up
Macrofils:– large particle– durable– low shine
Microfils:– small particle– low strength– high shine
Hybrid:– combination of macro
and micro– durable and higher shine
than macro
Laminating:– layering of composite
material– Macrofil for durability– Micro for high shine
COMPOSITE PLACEMENT
Mechanical and chemical retention
tooth preparation differs from amalgam
acid etch, primer, bond materials
Basic process– anesthesia, shade
selection, isolation, prep– placement of matrix,
mylar or stainless steel and wedges
– place composite– finish with finishing disc
or burs
Shade Selection
Must be selected in natural light Done before isolation Done while teeth are naturally wet with saliva Best to check right after anesthetic is given
Etching systems
Removes smear layer Phosphoric acid, maleic acid, or hydrochloric
acid Critical step in bonding enamel and dentin
surfaces to resin/composite materials
Enamel Bonding
Includes:– Sealants– Bonded orthodontic brackets– Resin bonded bridges– Bonded veneers
Usually bonded directly to enamel surface Dentin Bonding - involves removing the
smear layer
Smear Layer
Very thin layer of debris composed of fluids and tooth components
1000’s of dentinal tubules are cut during preparation of tooth
Open ends can transmit fluids and micro-organisms to the pulp of the tooth
May result in PO sensitivity, pain, or even damage to the pulp
Smear Layer
Described as nature’s bandage Protects the tooth by closing off the openings
of the dentinal tubules Must be removed and tubules re-opened as
part of the bonding process where they are sealed with primer and bonding agents
Laminating Technique
Layers or thin stacking of composite Light cure between layers to reduce
shrinkage
Many Different Materials
GLASS IONOMERS
Type I, II, III, IV and Type II restorative
– used as esthetic restoration
– non stress bearing areas
Powder and Liquid– dispensed and mix– capsule form– fluoride release
Class V restorative– root repair
Pediatric restorative Light cure Self cure
Many Choices
Core Buildups
Materials used:– Amalgam– Composite– Glass Ionomer
Replaces missing tooth structure
Give support to remaining tooth structure
Matrices– Stainless Steel– Mylar strips– Crown Formers
Additionally– Titanium pins can be
added for strength
Core Buildups
BLEACHING
Extrinsic– tobacco– coffee– tea
Intrinsic– tetracycline– dental fluorosis– non-vital
Considerations– amount of stain– origin– cost– difficulty
Methods– home bleaching– in office
Bleach or Not to Bleach????
Bleaching Techniques
Non-vital bleaching (walking bleach)– Thick paste of hydrogen peroxide and sodium perborate
placed in the tooth and covered– Patient can leave and return to remove and finish treatment
Vital bleaching (in office)– All teeth are isolated with a dental dam and cleaned with
pumice– Apply liquid or gel bleach on teeth and light cure– Sometimes called power bleaching
Bleaching Techniques
Take home bleaching (mouth guard bleaching)– Most common– Used with dental trays– Dental assistant does majority of these visits– Patient takes bleach home and uses in dental tray
for 1 to 2 hours daily until goal shade is reached
WALKING BLEACH TECHNIQUE
Used for endodontically treated teeth
sodium hyperborate, hydrogen peroxide
Bleach placed, patient dismissed, returns one to two days for color check
Many Choices